1. Infants and young children

During emergencies, newborn and child morbidity and mortality rates have been observed to rise drastically. Malnutrition has a deleterious impact on cognitive, motor-skill, physical, social, and emotional development in children. Specific actions are required during emergencies to protect and promote appropriate newborn and child feeding behaviors, as part of calculating food and nutritional needs. Any relief response should include these treatments regularly, and they should be maintained throughout the response.

• Breastfeeding

Breast milk is the best meal for newborns and young children’s healthy growth and development. Breast milk has a higher availability of nutrients than any other alternative. Breast milk not only meets all of an infant’s nutritional needs, but it also protects them from infection. Breastfeeding exclusively for the first six months of life can also work as a contraceptive for the mother since she avoids the depleting effects of several pregnancies. Breastfeeding also strengthens the link between mother and child, offering physical and emotional support to the infant. Breastfeeding becomes much more crucial for infant nutrition and health in most circumstances. Water, fuel, and proper quantities of newborn formula—all of which are required for safe artificial feeding—are frequently scarce.

In these situations, artificial feeding raises the risk of diarrheal illnesses and malnutrition, which increases the risk of newborn death significantly. If infant formula is necessary, it should only be used after all other choices (such as wet-nursing) have been exhausted. As a result, infant formula should only be purchased and distributed based on needs evaluations conducted by nutrition and health professionals who are properly qualified. In cases where formula is utilized, strategies should be devised to promote best practices. If infant formula is used, it should be labeled generically and with reconstitution instructions in the local language.

Supplemental feeding could be a useful intervention for protecting the nursing mother’s nutritional status and maintaining the nutritional content of breast milk. Support and encouragement may also be required to maintain and improve breastfeeding in those who are under a lot of stress.

• Breastfeeding and HIV

Because HIV can be transmitted through breast milk, recommended nursing methods for HIV-positive women may differ. If the newborn is breastfed for 18 to 24 months, the risk of mother-to-child HIV transmission (MTCT) through breastfeeding is between 10% and 20% globally. Infants who are not breastfed, on the other hand, may be at a higher risk of morbidity and mortality from malnutrition and viral infections other than HIV.

Guiding principles for feeding infants (0-6 months) during emergencies

1. According to WHO guidelines, all newborns, even those born into emergency-affected communities, should be breastfed exclusively for the first six months.

• The importance of colostrum in breast milk is particularly significant; newborns should be breastfed on demand from the moment they are born.
• Every attempt should be made to find solutions for newborns whose moms are away or handicapped to be breastfed.
• Re-lactation should be attempted before considering the use of infant formula.

2. Every effort should be made to create and maintain an environment that promotes exclusive breastfeeding for the first six months and frequent breastfeeding for the next two years.
3. At emergency sites, the quantity, distribution, and use of breast milk substitutes such as infant formula should be monitored.

• Nutritionally adequate infant formula, fed by cup, should be available for infants who do not have access to breast milk.
• Those responsible for feeding infant formula should be adequately trained and equipped to ensure its safe preparation and use.
• Feeding infant formula to a minority of children should in no way interfere with protecting and promoting breastfeeding for the majority.
• The use of infant feeding bottles and artificial teats in emergency settings should be actively discouraged and cup feeding promoted instead, as cups are much easier to keep clean.

In a typical emergency, the majority of women have no idea whether or not they have HIV. The availability of voluntary counseling and testing (VCT) is critical for women to be able to make educated decisions about newborn feeding.

Current HIV-infected women’s breastfeeding and infant feeding policies:

1. For six months, exclusive breastfeeding should be preserved, promoted, and supported. This is true for both women who are known to be HIV-negative and women whose infection status is unknown.
2. Avoiding breastfeeding by HIV-positive mothers is advocated when replacement feeding is acceptable, practicable, economical, sustainable, and safe; otherwise, exclusive breastfeeding is encouraged throughout the first months of life.
3. Breastfeeding should be stopped as soon as possible to reduce the risk of HIV transmission, taking into account local circumstances, the particular woman’s position, and the hazards of replacement feeding (including infections other than HIV and malnutrition).
4. HIV-positive women should have access to information, follow-up clinical care, and support services, such as family planning and nutritional assistance.

2. Complementary feeding for older infants and young children

Infants should begin receiving complementary foods in addition to breast milk at the age of six months. To satisfy the infants’ evolving nutritional requirements, these should be carefully made from locally accessible foods that are high in calories and micronutrients. Because there are typical limits, this can be a big difficulty during an emergency. Readily available foods may be challenging to transform into a soft, semi-solid state. Food preparation and feeding may be hampered by environmental factors. It’s possible that traditional ingredients for weaning foods won’t be available. Furthermore, basic food-aid commodities such as grains, pulses, and oil are insufficient to cover the nutritional needs of young infants on their own.

Easily digestible foods are required throughout the supplemental feeding stage for older infants and young children. Complementary foods consumed during this time should also supply enough levels of fats and oils (30–40% of total energy should come from fat). Because of rapid growth and an increasing need for complementary foods, the period from 6 to 24 months is the most critical for a young child. As a result, protein-derived energy should account for at least 12% of total energy. For proper growth and development, these young children must have access to diets rich in micronutrients.

Breast milk generally continues to fulfill around half of an infant’s nutritional needs during the second six months of life. It can give 35-40% of overall energy consumption during the second year. There are a variety of foods that can be used to make excellent supplemental foods in an emergency circumstance.

Options for addressing nutritional needs of older infants and young children

1. Basic food-aid commodities from general ration supplemented with low-cost foods accessible locally.

– Cereals, pulses, oil, and sugar, as well as a range of vegetables and fruits (cereals and pulses must be prepared using ground or milled forms).

– Cereal and pulse blends with additional oil and sugar, perfect as a complement to other dishes.

– Recipes can be created with the help of nutrition and/or health experts, utilizing local ingredients.

– It is necessary to examine and comprehend traditional supplementary feeding practices.

2. Blended foods (as part of a general ration, as a blanket, or as a supplement).

– Corn-Soya Blend (CSB), Wheat-Soya Blend (WSB) – FAMIX in Ethiopia, and UNIMIX in Kenya are examples of locally made blended meals.

– Blended foods that have been roasted or extruded to improve their digestion.

– Additional oil is usually necessary for the preparation; DSM can be added as a protein source and to improve palatability.

– Blended foods are frequently fortified with zinc, iron, and other minerals for growth and development.

3. Additional foods in supplementary feeding programs.

– Fruit, vegetables, fish, eggs, or other suitable locally available foods

-Valuable source of vitamins and minerals.

Challenges and implications for planning food needs for older infants and young children

• Feeding frequency:

Due to limited stomach capacity, food needs to be provided frequently by ensuring:

➪ Provision of sufficient fuel and cooking pots for households with young children.

➪ Supply of food-aid commodities is consistent and timely to facilitate appropriate food-preparation practices.

➪ Recognition of time required by the caregiver for food-preparation activities.

• Household food security:

Household food security may contribute to intra-household food distribution that does not allow the nutritional needs of young children to be met.

➪ Adequate and equitable general ration.

➪ Household monitoring as part of the general monitoring system.

➪ Community-based surveillance to identify problems related to intra-household distribution.

• Safe and appropriate food preparation and caring activities:

Lack of access to clean water, poor sanitation, inexperienced caregivers, and mothers overburdened with meeting household food needs may contribute to abnormal and inadequate caring practices. Feeding of orphans (particularly in situations where HIV/AIDS prevalence is very high).

➪ Health-promotion activities for safe food preparation and dissemination of information on nutritional needs of young children.

➪ Access to adequate amounts of clean water and provision of suitable sanitation facilities.

➪ Additional resources to create a special and appropriate system to care for those children, preferably in a family environment.

3. Pregnant and lactating women

Women’s dietary needs for calories, protein, and minerals increase dramatically during pregnancy and lactation. Pregnant women need an extra 285 kcals per day while breastfeeding women need an extra 500 kcals per day. Micronutrient requirements are higher in both pregnant and breastfeeding women. Iron, folate, vitamin A, and iodine are very vital for the health of both mothers and their babies. In many cases, intra-household food distribution patterns cause pregnant and nursing women to consume less than their basic requirements. Poor nutritional status and inadequate nutritional intake for pregnant and lactating women have a direct impact on the woman’s health, as well as a negative impact on the infant’s birth weight and early development.

As a result, in addition to providing a basic food ration, three crucial and complementary interventions may be conducted to address the unique requirements of pregnancy and lactation. The increased micronutrient needs of pregnant and lactating women, on the other hand, may not be addressed by providing a basic ration. There are several criteria for determining when a supplementary feeding program should be established.

Complementary interventions to meet the additional needs of pregnant and lactating women

1. Fortified food commodities

The food should be provided in addition to the basic general ration, either through the same mechanism as the general ration distribution or through MCH facilities as a blanket supplementary feeding ration. The food should be targeted to women in their second and third trimesters of pregnancy and during the first six months of the lactating period (i.e., for a total period of 12 months.

– Provision of fortified blended food commodities, designed to provide 10–12% (up to 15%) of energy from protein and 20–25% energy from fat. The blended food must be fortified to meet two-thirds of daily requirements for all micronutrients, particularly iron, folic acid, and vitamin A.

– The food commodities can be provided through maternal and child health (MCH) structures (in conjunction with other health services) or through blanket supplementary feeding programs.

2. Micronutrient supplement

Pregnant women: Daily supplements of iron (60 mg/day) and folic acid (400 µg/day).

Lactating women: Vitamin A: 400 000 IU in 2 doses of 200 000 IU in at least 24 hours within six weeks after delivery.

3. Drinking water

Women are ensured access to sufficient drinking water (extra 1 liter of clean water per day).

4. Malaria management in pregnancy

– In areas where malaria is endemic, sulphadoxine-pyrimethamine can be administered through clinics at the beginning of the second and third trimesters.

– Encourage women to use an impregnated bed net during pregnancy.

– Advise women that they must seek immediate medical attention for episodes of fever.

5. Prophylaxis for management of intestinal parasites

Give each affected woman 500 g mebendazole, in the second and the third trimester.

6. Nutrition/education counselling for women and communities

4. Older persons

The energy requirements of older people (defined by WHO as those over the age of 60) are typically lower than those of younger people due to less physical activity and a lower basal metabolism caused by a greater proportionate loss of muscle mass. Micronutrient needs, on the other hand, do not diminish. As a result, even with reduced energy intakes, a balanced diet for older people must guarantee that micronutrient requirements are satisfied (i.e., foods must be sufficiently nutrient-dense).

Another factor to consider for elderly people is that adequate fluid intake is necessary to avoid dehydration and promote digestion. In theory, a well-planned general ration is usually sufficient for elderly people. In practice, however, a variety of other circumstances frequently result in the general ration failing to meet the nutritional needs of the elderly. Low physical access to the ration as a result of marginalization or isolation; poor digestibility, particularly of whole-grain cereals; lack of motivation or inability to prepare foods; and worse access to chances for supplementing the ration are only a few of these problems. These variables are amplified in emergencies due to a broad breakdown in usual family and community support mechanisms.

Let’s discuss some techniques that should be examined in order to better meet the nutritional and food demands of older people.

Considerations to the nutritional and food needs of older persons

• Access to foods that are easily digested and high in micronutrients

– Blended foods should be offered to elderly people, or to households with older people. In instances where blended food is not available to the entire population, children under the age of five, pregnant and breastfeeding women, and the elderly should be given priority.

– In instances where whole-grain cereal is provided, access to milling facilities.

– To improve the intake of fresh foods, elderly people (caregivers/families) should be aided and encouraged to participate in small-scale horticultural activities.

• Family and community support for food preparation.

Community-based assistance programs can help older people who do not have family or community support.  Older people may require assistance with duties such as ration collecting, food preparation, and water collection.

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